Esophageal cancer, particularly esophageal squamous cell carcinoma (ESCC), is a major global health issue, with a significant prevalence in China. The disease is complicated by its late diagnosis and poor prognosis, exemplified by a five-year survival rate of merely 15-25%. A severe complication of ESCC is the development of tracheoesophageal fistula (TEF), which can arise from advanced disease or treatment-related factors, leading to symptoms such as cough and respiratory distress. This case report presents a unique instance of a patient with ESCC complicated by TEF and concomitant coronary heart disease, illustrating the diagnostic challenges posed by overlapping clinical manifestations. The misattribution of TEF symptoms to disease progression emphasizes the necessity for heightened clinical suspicion and the implementation of tailored management strategies. The complexity of this case highlights the importance of a multidisciplinary approach involving oncologists, cardiologists, and critical care specialists to optimize patient care and outcomes. Furthermore, it underscores the critical need for early recognition and individualized treatment plans to address the diverse clinical presentations and therapeutic responses in this patient population. While this case contributes valuable insights to the existing literature, it also calls for larger multicenter studies to validate findings and develop standardized protocols for managing TEF in patients with esophageal cancer. Ultimately, advancing our understanding of the interplay between esophageal cancer and its complications is essential for improving survival rates and the quality of life for affected individuals, with this case serving as a foundational reference for future research endeavors.